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下壁心肌梗塞初始向量向上,在Ⅱ、Ⅲ、avF导联形成病理性Q波,但LAH的初始向量向右向下,在Ⅱ、Ⅲ、avF导联形成r波,故下壁心肌梗塞合并LAH使两者图形互受影响,互相掩盖,形成心电图诊断上的困难。 (一)下壁心肌梗塞心电图形:下壁心肌梗塞初始向量向上,至少需>-30°才能在Ⅱ、Ⅲ、avF导联构成Q波,如向上向量不足-30°,则仅在Ⅲ、avF导联形成Q波,此时心肌梗塞的诊断需参照电轴左偏程度,由于隔面心肌电活性丧失,而使QRS环体向左向上移位,形成左偏电轴,故电轴左偏<+10°,QⅡ、avF则应考虑下壁心肌梗塞的诊断。但如合并LAH,上述特征丧失。
The initial vector of the inferior myocardial infarction is upward, forming a pathological Q wave in the leads of II, III and avF, but the initial vector of LAH is rightward and downward, forming r waves in the leads of II, III and avF, so the inferior myocardial infarction LAH mutual influence between the two graphics, mutual cover, the formation of ECG diagnostic difficulties. (A) ECG of the inferior myocardial infarction: the initial vector of the inferior myocardial infarction up, at least> -30 ° in the Ⅱ, Ⅲ, avF lead constitute Q wave, if the upward vector is less than -30 °, only in Ⅲ, avF lead to form Q wave, then the diagnosis of myocardial infarction need to refer to the left axis of the degree of deviation, due to the loss of septal myocardial electrical activity, leaving the QRS ring left shift up to the left axis, so the left axis Deviation <+ 10 °, Q Ⅱ, avF should consider the diagnosis of inferior myocardial infarction. However, such as the merger of LAH, the above characteristics are lost.